America lamenting her loss at the tomb of Washington

In the normal course of our lives, when we become adults we leave home and begin living our own lives geographically and/or socially separate from our parents. To a certain extent, our relationships with our parents, grandparents, and other family members evolve. The role of members of the older generations becomes one of providing advice and support – emotional and, sometimes, financial. The relationships become more adult-based while at the same time maintaining varying degrees of simplicity, ambivalence, ambiguity, and complication from our childhood. Of course, you might think, “That certainly doesn’t describe my relationship with MY parents! They have never given me any support or advice.” Some people do not have a relationship with their (grand)parents that they hold dear, but deep down they may WISH that they did. The idealized relationships we long to have with our elders can be very important in our mourning, as we shall see later.

All of the same issues – dilemmas, guilt, and relationships – I have written about in the past three weeks apply equally to a perinatal loss. However, after a miscarriage, stillbirth, health-related termination, or early infant death, parents must shoulder burdens not present in other losses: the hesitancy of others to recognize the personage of the baby, the difficulty in finding support, the decision of if and when to try to have another, and the anxiety of a possible loss during a subsequent pregnancy.

When adolescents suffer the death of someone they love, three variables have a major impact on how they react: how they already think of themselves, the presence of any depression, and their relative age. Bereaved adolescents who have a positive self-image (high self-concept) are more likely to have less depression, fear, loneliness, and confusion. Those adolescents who have an average self-concept typical show more depression, loneliness, and anger while those with a low self-concept show more confusion, but less anger. In short, according to a study by N. S. Hogan and D. B. Greenfield, after the death of a loved one, adolescents with a high self-concept experience a lower intensity of grief, and vice versa.

There are many facets to our identity. Most people think of identity as being composed of the roles we assume in life, our heritage, our environment, our spiritual beliefs, etc. For example, I am a counselor, a college graduate, an American, a Texan, a rower, a cook, a husband, a brother, a son, a teacher, etc. These are all roles I have, each carrying with it certain behaviors and actions. Roles describe what I am and what I do. However, if all of these roles were stripped away, who would remain? Who is at the core of my being? Who am I?

If the death of parents and grandparents represent the loss of our connections to generations past, the death of a spouse/partner represents the loss of a major connection we have with the present and foreseeable future. The love and the bonds we have for our spouse/partner give us an almost mystical completion of ourselves. When death visits and disrupts those bonds, we can like feel that not only did our spouse die, but so did a part of us.

If the death of parents and grandparents represents the death of our connections to the past, and the death of our spouse/partner represents that to the present and our seeable future, then the death of a child represents the death of a connection to the future. Virtually everyone who has incurred this loss agrees that there is no other loss as painful as that of a child. (While perinatal losses share the same characteristics as the loss of any other aged child, they have additional characteristics that I will address later.)

Guilt is a feeling that arises when we believe that we have violated some responsibility, higher principle, or belief. Guilt carries with it a lowered self-esteem, heightened self-blame, and a feeling that we should do something to absolve ourselves of the wrong we committed. While guilt can be well founded and realistic, in most cases involving the death of a child it is more of a reaction to feelings of helplessness and responsibility. Parents begin to believe that they must have done, said, or felt something that contributed to their child’s death. Parents compare their actions against some idealized standard and if they discover a discrepancy, the death becomes their fault. Such statements as, “If I had only _______ my child would be alive today!” become part of their thinking when, in reality, there was nothing they could have done to change the course of events.

A major concern many parents have after the death of their child is how the loss will affect their marriage. A common misconception is that parents who have lost a child are more likely to get a divorce. That is not necessarily true. Instead, my experience and that of others is that the death of a child does not cause a divorce, it intensifies the nature of the relationship the parents already had. In working with bereaved couples and individuals, I have seen couples who are open and supportive of each other develop an even stronger relationship. They lean on each other for support as they strive to make meaning, both individually and as a couple, of the death. Neither one tries to avoid the pain, but mourns in his/her own particular way. They recognize that each of them may mourn differently – the father is probably more instrumental and the mother probably more intuitive – and they allow for those differences.

William Worden and others conducted a two-year study – the Harvard Child Bereavement Study – on the effects of the death of a parent on children. Worden presented the findings from that study in the book Children and Grief: When a Parent Dies.

While styles of grieving differ among children – just as they do among adults, the developmental stages of children also give rise to specific needs that adults should be aware of and be prepared to help address. William Worden has recognized 10 of these.